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Trust for America's Health
Docs Should Play Role in Increasing Immunization Uptake in Adults
According to Schaffner, professor and chair of the department of preventive medicine at Vanderbilt University School of Medicine, the vast majority of vaccine-preventable disease, hospitalizations and deaths in the United States occur among adults. "The country has an absolutely stunningly first-rate system for immunizing children, but too many adults still fall through the cracks," he said. "It's really time to build a better strategic approach for systematically immunizing adults."
The report found that uptake is extremely low among adults for several recommended vaccines. For example, only 2.1 percent of U.S. adults aged 18-64 have received the tetanus toxoid, reduced diphtheria toxoid and acellular pertussis, or Tdap, vaccine. Less than 2 percent of adults aged 60 and older have received the herpes zoster vaccine.
The report suggests that physicians could play a large role in preventing disease and lowering health care costs by increasingly encouraging their adult patients to get vaccinated. The report recommends that
- physicians make it standard practice to review patients' immunization histories and offer vaccinations during appropriate medical encounters, such as cancer screenings and prenatal visits;
- hospitals and medical practices promote the use of standing orders for vaccinations;
- physicians use electronic medical records and immunization registries to improve information sharing among physicians and to generate reminders to physicians and patients about recommended vaccinations; and
- health care workers reduce transmission of disease and set an example by complying with immunization recommendations, including annual flu vaccinations.
As for health care worker immunizations, AAFP members report that 92 percent of their employees are routinely immunized against influenza, and 88 percent report that their employees were immunized against Hepatitis B. However, less than half (42 percent) report that their staffs have been immunized with the Tdap vaccine.
Setting a Good Example
- Health care personnel, who can cause flu outbreaks among patients and long-term care residents, should be vaccinated for influenza every year.
- Hepatitis B vaccine should be given to protect workers who are in contact with blood, body fluids or used needles.
- Health care workers who are not already immune to measles, mumps and rubella should receive the MMR vaccine. Even mild or undetectable rubella disease can cause birth defects.
- Health care workers need a booster dose every 10 years for tetanus and diphtheria, or Td, vaccine. The tetanus toxoid, reduced diphtheria toxoid and acellular pertussis, or Tdap, vaccine should replace a single dose of Td for adults who have not received a dose of Tdap previously.
- Health care workers who are not already immune should receive two doses of varicella vaccine.
Furthermore, some private insurance companies do not cover adult vaccines and administration costs; Medicaid coverage varies by state. Provider limitations and challenges related to storing vaccine and patient concerns about safety and effectiveness are factors as well, according to the report.
"This country does not have an effective strategy for immunizing adults against infectious diseases," Jeffrey Levi, executive director of Trust for America's Health, said during the media briefing. "Thousands of lives could be saved each year if we could increase the number of adults who receive routine and recommended vaccinations. We need a national strategy to make vaccines a regular part of medical care and to educate Americans about the effectiveness and safety of vaccines."
The report offers several recommendations regarding insurance issues and government funding, including calling for
- increased funding for the Section 317 program, which provides vaccines to underinsured children, adolescents, and to a lesser extent, uninsured and underinsured adults;
- the creation of a Vaccines for Uninsured Adults program that would be similar to the CDC's Vaccines for Children program;
- coverage of all recommended vaccines under Medicare Part B, rather than the current system which has some vaccines under Part B and others under Part D;
- private payers to cover all recommended vaccines using administration fees covered by Medicare Part B as a minimal standard; and
- additional congressional support of research into adult vaccines and increased support for state and local health departments.
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More From AAFP
Recommended Adult Immunization Schedule
(2-page PDF; About PDFs)
CDC: Vaccines and Immunizations